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The    Achievements,    Standards   and 

Prospects    of    the 
Massachusetts     General     Hospital 


Ether    Day    Address 
1919 


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The   Achievements,    Standards   and 

Prospects     of    the 
Massachusetts     General     Hospital 


RICHARD    C.    CABOT,    M.  D. 

Professor  of  Medicine 
Harvard  Medical  School 

Chief  of  West  Medical  Service 
Massachusetts  General  Hospital 


Ether   Day  Address 
1919 


THE     ACHIEVEMENTS,    STANDARDS 
AND   PROSPECTS  OF  THE   MASSACHU- 
SETTS  GENERAL   HOSPITAL 


ETHER  DAY  ADDRESS* 

By 

Dr.  Richard  C.  Cabot 

October  16,  19 19 

Our  celebration  of  Ether  Day  this  year  has  something 
the  aspect  of  a  reunion.  Those  of  us  who  love  and 
serve  this  hospital  have  not  been  together  before  for 
three  years.  But  your  foreign  branch,  your  foreign 
representatives,  whom  you  sent  to  do  the  foreign  part 
of  this  hospital's  work  in  France  and  England,  did  not 
forget  the  anniversary  day  on  which  the  adherents 
and  friends  of  this  hospital  are  accustomed  to  gather 
up  the  traditions  of  their  past,  to  take  account  of  stock, 
and  to  ask  for  such  visions  of  the  future  as  may  guide 
it  fruitfully. 

We  celebrated  Ether  Day  in  19 17  at  Bordeaux;  in 
1918,  in  London.  The  tradition  has  not  been  broken, 
at  least  so  far  as  the  loyalty  and  devotion  of  our  leader, 
Dr.  Washburn,  could  preserve  it.  He  gathered  us 
together  in  the  chilly  October  of  Southern  France, 
in  a  bare  and  draughty  building,  to  commemorate  as 
best  we  could  our  home  and  our  roots  in  this  old  insti- 
tution at  Boston.  Again,  in  October  of  19 18,  he  gath- 
ered together  in  London  such  servants  and  graduates 
of  the  hospital  as  he  could  find,  at  a  meeting  honored 

•Address  delivered  at  the  Massachusetts  General  Hospital  on  the 
seventy-third  anniversary  of  Ether  Day,  October  16,  1919. 


by  the  presence  and  by  the  appreciative  remarks  of 
Sir  William  Osier. 

Since  the  trustees  have  chosen  for  the  speaker  of 
this  afternoon  one  who  has  no  extensive  or  accurate 
knowledge  of  ether,  and  who  can  bring  with  him  the 
prestige  of  no  special  achievements  in  science  per- 
formed in  another  part  of  the  country,  but  have  se- 
lected a  member  of  our  own  family  group,  it  seemed 
to  me  proper  that  the  topic  for  today  should  be  one 
needing  no  special  fitness  on  the  part  of  the  speaker 
except  knowledge  of  the  hospital  and  affection  for  it 
extending  over  thirty  years. 

Just  three  decades  have  passed  since  I  first  began  to 
be  acquainted  with  the  multifarious  and  incessant  ac- 
tivities of  the  Massachusetts  General  Hospital.  Using 
my  own  personal  knowledge  of  these  30  years,  and 
supplementing  it  by  the  writings  and  recollections  of 
others,  I  wish  today  to  pass  in  review  the  achievements, 
standards,  and  prospects  of  this  hospital.  I  shall  pay 
special  attention  to  the  years  since  1871,  at  which  date 
the  official  volume  narrating  the  history  of  this  hos- 
pital terminates.  In  this  survey  I  shall  be  guided 
by  the  belief  that  there  are  three  main  functions,  by 
success  or  failure  in  which  any  hospital  should  be  judged. 
It  is  the  business  of  a  hospital: — 

{a)  To  apply  the  best  of  existing  medical  and  sur- 
gical knowledge  to  the  comfort  and  healing  of  body 
and  soul. 

(b)  To  extend  this  knowledge  through  example, 
teaching  and  research. 

(c)  To  extend  our  vision  and  our  influence  beyond 
the  hospital's  walls. 

The  first  two  of  these  purposes  comprise  what  may 
be  called  the  domestic  policy  of  the  hospital  and  the 
third  its  foreign  policy.  Medicine  like  charity  begins 
at  home. 


I 

Devoted  Care  of  Patients 

Our   first    and    foremost    duty    must    be    our    ward 
service,  the  detailed  care  of  such  patients  as  we  find 
day   by   day   in   the   wards   and   in   the   Out-Patient 
rooms  of  our  hospital.     This  has  been  somewhat  cyn- 
ically spoken  of  as  the  duty  of  "maintaining  a  repair 
shop."     Surely  we  must  maintain  a  repair  shop  and 
an  excellent  one.     The  repair  of  his  wounds  and  ills 
is  what  the  patient  most  poignantly  desires.     But  we 
have  never  been  merely  a  repair  shop.     Our  attack 
upon  the  body's  ills  has  never  been  merely  the  mechan- 
ical and  the  chemical  attack.     For  mechanics  and  chem- 
istry can  be  applied  as  well  to  the  body  of  an  automo- 
bile as  to  the  body  of  a  man.     From  the  very  opening 
of  this   hospital,    September   3,    1821,   when   the   first 
patient  was  received,  Dr.  James  Jackson  and  Dr.  J.  C. 
Warren  set  a  standard  for  the  care  of  patients  which 
in   many  respects   we    cannot    hope   to   excel.     They 
realized  from  the  first  that  it  was  unscientific  as  well 
as  inhuman  to  ignore  the  sick  mind  in  the  sick  body, 
to  forget  the  one  function  which  integrates  and  rep- 
resents  all  the  other  functions  of  our  organism.     As 
they  ministered  day  by  day  to  diseased  bodies  we  can 
imagine  these  first  leaders  of  our  hospital  traditions 
confronted  with  the  pathetic  question:  "Canst  thou 
minister  unto   a   mind   diseased?"     In   their  life   and 
practise  the  first  physicians  of  this  hospital  answered 
"Yes."     And   they   answered   so   clearly  and   consist- 
ently that  their  influence,  the  tradition  of  Jackson  and 
Warren,  has  persisted,  I  believe,  even  to  this  day. 

In  the  Annual  Report  for  1867,  the  precise  but  un- 
inspired style  characteristic  of  our  Annual  Reports 
rises  to  true  eloquence  for  once  in  their  hundred  years' 
extent.  That  was  the  year  of  Dr.  James  Jackson's 
death,  and  in  the  resolutions  upon  this  event  the 
Trustees  say: 


"His  personal  as  well  as  professional  qualities,  his 
activity  without  imprudence,  his  decision  without  dog- 
matism, his  conscientiousness  that  never  provoked, 
his  exhaustless  sympathies  which  made  him  the  father 
or  the  brother,  as  well  as  the  physician,  of  those  to 
whom  he  ministered,  bearing  their  troubles  as  his  own 
and  alleviating  by  the  charm  of  his  presence  the  pains 
he  could  not  remove  by  his  skill,  —  his  unwearied 
study,  his  fruitful  knowledge,  his  contributions  to  the 
science  and  literature  of  medicine,  and  his  relations  to 
the  elder  and  younger  members  of  the  profession  gave 
him  a  position  at  the  hospital  as  exclusively  his  own  as 
that  which  he  held  in  the  community." 

Since  that  time  our  daily  ward  service  has  repre- 
sented, I  think,  the  conscious  attempt  to  continue  that 
tradition  unimpaired.  To  make  possible  the  conti- 
nuity of  this  standard  it  has  been  necessary  that  the 
trustees  should  consider  always  the  character  as  well 
as  the  professional  attainments  of  those  appointed  to 
serve  in  the  hospital  wards.  Men  of  conscience,  of 
culture,  of  sympathy  and  integrity  have  been  con- 
stantly appointed  upon  our  staff.  The  intellectual 
and  moral  standards  of  this  staff  have  been  always  its 
most  impressive  lesson  to  the  long  procession  of  House 
Officers  and  junior  physicians  who  have  passed  through 
this  hospital. 

Some  years  ago  two  very  promising  young  House 
Officers  graduated  from  this  institution  and  settled 
with  brilliant  financial  prospects,  one  of  them  in  Cin- 
cinnati, the  other  in  Chicago.  Within  two  years  each 
of  these  men  wrote  independently  to  a  member  of  our 
staff  asking  if  it  would  not  be  possible  for  him  to  come 
back  here  on  some  terms.  They  were  willing  to  give 
up  first  rate  financial  prospects  for  a  bare  subsistence 
in  this  neighborhood,  because  their  contact  with  the 
tradition  of  Jackson  and  Warren  as  passed  down  to 
them  by  such  physicians  as  Dr.  Frederick  C.  Shattuck, 
Dr.   James  Minot,   Dr.   E.   C.   Cutler,   and  Dr.  John 

6 


Collins  Warren,  had  spoiled  them  for  commercialism 
in  medicine.  They  had  found  here  certain  ethical  and 
intellectual  standards  taken  as  a  matter  of  course.  I 
mean  the  wise  man's  honest  confession  of  ignorance, 
the  absence  of  suspicion,  secrecy  and  backbiting,  the 
rule  of  fairness  to  others,  the  habitual  thoroughness  of 
examination,  record  and  subsequent  study,  the  habit- 
ual courtesy  under  conditions  which  tempt  us  to  a 
bald  and  mechanical  type  of  intercourse,  —  all  this 
had  sunk  into  their  minds  as  it  has  sunk  into  those  of 
generation  after  generation  of  young  physicians  pass- 
ing through  their  period  of  service  in  this  hospital. 

These  high  standards  in  the  performance  of  the  day's 
work  involve  the  double  ability  to  find  interest  in  what 
seems  monotonous  and  to  bring  interest  into  it.  The 
ability  to  be  astonished  and  to  be  delighted  is  one  of  the 
most  reviving  and  sustaining  characteristics  of  the 
tradition  passed  on  by  our  staff.  I  shall  never  forget 
the  lighted  eye  and  kindled  accent  with  which  Dr. 
Frederick  C.  Shattuck  was  accustomed  when  con- 
fronted with  a  fine  example  of  disease,  to  say,  "God 
bless  my  soul!     Did  you  ever  see  anything  like  that?" 

This  spirit  has  been  possible  because  the  members 
of  our  staff  have  been  accustomed  to  bring  the  best  of 
themselves  with  them  to  the  hospital  and  not  to  leave 
behind  them  at  home  all  except  their  technical  equip- 
ment. They  have  brought  with  them  to  the  hospital 
not  merely  their  keen  intellects  and  their  well  stored 
memories,  but  their  other  human  interests.  So  Dr. 
Whittier  brought  always  his  still  burning  memories 
of  the  Civil  War.  Dr.  J.  Mason  Warren  used  often 
to  bring  his  children  with  him  upon  his  hospital  visits, 
and  many  of  us  remember  an  amazing  and  mirth- 
producing  dachshund  which  followed  Dr.  Shattuck 
about  the  wards. 

We  should  be  foolish  to  ignore  here  the  influence  of 
heredity.  If  medical  science  has  taught  us  anything 
it  is  that  blood  tells,  that  stock  is  a  fundamental  factor 

7 


in  human  worth  and  achievement.  Hence,  the  better 
members  of  our  staff  have  passed  on  the  accumula- 
tions of  a  hundred  years  of  strenuous,  intelligent  and 
conscientious  living,  the  gleanings  of  two  continents, 
the  fruits  of  humane  culture. 

It  has  never  been  better  exemplified  than  in  this 
hospital  that  true  greatness  is  characterized  especially 
by  modesty  and  unpretentiousness,  that  merit  does 
not  have  to  trumpet  its  claims  by  titles  or  decorations 
nor  to  hedge  itself  around  with  a  wall  of  aloofness. 
Our  models  and  teachers  in  the  daily  work  of  the  wards 
have  been  as  ready  to  learn  as  to  teach,  and  to  learn 
even  from  their  youngest  and  crudest  assistant. 

The  tradition  that  I  have  tried  to  describe  is,  I  be- 
lieve, a  genuine  and  persistent  characteristic  of  our 
city.  Boston  is  no  longer  a  literary  centre,  if  it  ever 
was;  but  the  practice  of  humane  and  skilful  service 
is,  I  believe,  as  strong  with  us  at  this  hospital  today  as 
it  was  a  hundred  years  ago.  It  is  a  tradition  that 
holds  fast  something  of  the  best  yet  achieved  here, 
thus  by  conservation  making  true  progress  possible. 
And  because  many  men  have  built  their  lives  into  the 
structure  of  this  tradition,  giving  the  best  they  had  to 
offer,  the  spirit  of  this  tradition  is  greater  than  that  of 
any  single  man,  yet  has  an  individuality  all  its  own. 

II 

In  Tables  I  and  II  I  have  jotted  down  some  of  the 
most  important  items  of  our  achievement,  noting 
first  our  material  expansion  and  second  some  improve- 
ments in  the  quality  of  our  service.  We  have  become 
better,  I  think,  as  well  as  bigger.  But  I  will  speak  of 
our  material  growth  first,  though  in  some  cases  our 
growth  in  size  has  meant  an  improvement  in  quality. 

Material  Expansion 

The  first  twenty  years  of  the  hospital's  life  saw  the 
beginning  and  expansion  of  the  Bulfinch  building,  the 


corner-stone  of  which  was  laid  July  4th,  18 18,  a  cen- 
tenary which,  so  far  as  I  know,  we  did  not  notice  or 
commemorate  last  year. 

The  first  important  additions  were  the  group  of 
buildings  comprising  the  Thayer  dormitory  for  nurses, 
and  those  which  we  ordinarily  call  the  "lower  wards," 
A,  B,  C,  D,  E,  built  during  the  years  of  1874  to  J888 
and  providing  a  type  of  service  but  meagrely  secured 
in  the  older  building,  I  mean  the  advantage  of  private 
rooms.  In  1896  came  the  construction  of  the  new 
pathological  laboratory  and  the  power  house.  With 
this  laboratory  we  secured  one  of  the  most  important 
improvements  in  the  quality  of  our  work,  the  genius 
of  Dr.  James  H.  Wright  as  director  of  the  new  patho- 
logical laboratory.  All  that  now  goes  on  in  that  busy 
and  diversified  structure  had  to  be  done  till  1896  in 
a  dark  and  narrow  closet  which  now  makes  up  a  small 
section  of  the  Warren  Library,  a  closet  about  ten  feet 
by  six. 

Between  1900  and  1903  some  of  the  most  important 
of  the  buildings  now  in  use  were  added,  including  the 
new  operating  building,  the  domestic  building,  and 
last,  but  most  important,  the  new  Out-Patient  building. 
By  these  three  new  structures  I  think  we  can  say  that 
the  daily  work  of  the  hospital  took  on  quite  a  new  com- 
plexion. I  noticed  at  once  an  improvement  in  the 
patients'  diet  resulting  from  the  new  kitchen  arrange- 
ments of  the  domestic  building.  The  new  operating 
building  made  possible  much  better  organization  and 
multiplication  of  the  necessary  surgical  operations, 
while  the  new  Out-Patient  building,  the  finest  of  its 
kind  in  the  world,  brought  to  the  notice  first  of  our- 
selves and  later  of  the  rest  of  the  country,  the  central 
significance  and  value  of  Out-Patient  work. 

In  rapid  succession  followed  the  building  of  the  der- 
matological  and  orthopedic  wards,  and  not  long  after 
of  the  new  nurses'  home.  Finally,  in  1915  and  1917, 
came  the  last  and  in  some  ways  most  important  addi- 

9 


tions  to  our  plant,  the  Moseley  Administration  Build- 
ing (191 5)  and  the  Phillips  House  (1917). 

But  this  material  expansion  which  enabled  us  to 
care  for  more  patients  and  give  them  better  service, 
has  been  still  further  increased  by  improvements  in 
organization  and  in  treatment,  through  which  we  have 
cut  down  the  average  stay  of  the  individual  patient 
from  n  weeks  as  it  was  in  1855,  to  18  days  as  it  was  in 
1898,  and  approximately  11  days  as  it  is  now.  This 
enables  us  to  give  greater  public  service  without  in- 
creasing the  size  of  our  expensive  urban  plant.  The 
plans  for  a  country  branch  of  this  hospital  now  taking 
shape  in  the  minds  of  the  Trustees  will  enable  us  to 
cut  the  patient's  stay  in  this  urban  hospital  still  shorter 
and  so  to  serve  more  people. 

Table  I  —  Some  Significant  Dates 

1869  Lady  visitors  to  female  patients. 

1870  Lady  visitors  to  male  patients. 

1 871  Dr.  R.  H.  Fitz,  microscopist. 
1873  Nurses  Training  School  organized. 

1889     Dr.  R.  H.  Fitz,  pathologist.     (Appendicitis  1886.) 

1896     Dr.  J.  H.  Wright  and  Pathological  Laboratory. 

1903  New  Out-Patient  Department;  also  Children's  Serv- 
ice and  Skin  Ward. 

1905  Dr.  J.  H.  Pratt  and  Dr.  John  B.  Hawes  aggressively 
attack  Tb. 

1905     Social  Service. 

1907     Dr.  F.  A.  Washburn's  Administration  begins. 

1907  X-Ray  Department. 

1908  First  Continuous  Service  begins  (Dr.  F.  C.  Shattuck). 

1909  Practitioners'  Courses. 

191 1  Surgical  Residents  (Paid). 

1912  Staff  Reorganized;  Executive  Committee  created ;  Dr. 

D.  L.  Edsall  arrives. 

191 3  Department   of   Syphilis    (Drs.   Abner   Post   and    C. 

Morton  Smith). 
1913     Department  of  Industrial  Diseases  (Dr.  Wade  Wright). 
1913     Clinic  Secretaries. 

191 3     Medical  Resident  (Dr.  W.  W.  Palmer). 
191 3     Out-Patient  Department  fee  raised  to  25  cents. 

10 


191 5     Dr.  Washburn  proposes  Consultation  Clinic  for  per- 
sons of  moderate  means. 
191 5     Case  Records  begin  to  be  circulated. 

1917  Phillips  House. 

1918  Dr.  Edsall  organizes  research. 

191 8     Trustees  plan  hospital  for  persons  of  moderate  means. 

Improvements  in  the  Quality  of  Service 

(a)  Diversification  of  Service.  It  is  characteristic  of 
the  personal  devotion  traditional  in  our  profession  that 
the  doctor  is  wont  to  try  to  do  himself  everything  or 
nearly  everything  that  needs  to  be  done  for  the  patients. 
Thus  in  my  uncle,  Dr.  Samuel  Cabot's  time,  when 
the  use  of  the  clinical  thermometer  was  introduced,  all 
temperatures  were  taken  by  the  physicians  themselves. 
No  nurse  was  allowed  to  use  so  delicate  an  instrument 
of  precision.  So  until  very  recently  it  was  thought  a 
heresy  akin  to  scandal  to  suggest  that  patients  could 
be  admitted  to  the  hospital  wards  or  to  the  Out-Patient 
Department  by  any  one  except  a  physician.  Yet  this 
portion  of  our  routine  has  long  since  passed  over  to 
nurses. 

In  a  similar  way  a  considerable  portion  of  our  labo- 
ratory work  has  passed  into  the  hands  of  paid  technicians 
assisted  by  volunteers,  and  Fourth  year  medical  stu- 
dents are  now  employed  as  clinical  clerks,  for  a  con- 
siderable portion  of  the  year,  to  do  work  previously 
thought  proper  only  for  a  graduate  physician. 

The  management  and  marshalling  of  patients  in  the 
dispensary  clinics,  which  used  to  be  performed  by 
frantic  and  hasty  medical  assistants,  is  now  quietly 
and  deftly  performed  by  our  volunteer  clinic  secretaries. 

In  the  treatment  of  patients  we  have  summoned  to 
our  aid  not  merely  the  nurses  who  have  always  done 
so  much  of  it,  but  special  therapeutic  assistants  in  the 
departments  of  hydro-therapy,  mechanotherapy,  mas- 
sage, and  in  the  dietetic  management  of  diabetes. 
Cure  by  occupation  is  also  well  established  in  our  wards, 
owing  largely  to  the  devotion  of  Miss  Brackett. 

Something  of  the  variety  and  volume  of  service  now 

11 


given  in  this  hospital  can  be  seen  from  Table  II  (Per- 
sons serving  the  Hospital).  The  volume  of  service  is 
seen  in  Table  III. 

Here  I  should  like  merely  to  note  in  connection  with 
the  therapeutic  assistants  in  the  field  of  hydro-therapy, 
that  this  branch  of  service  began  in  June  1824,  when  a 
cold  and  warm  salt-water  bathing  house  was  erected 
on  the  seashore,  which  then  directly  touched  our  walls. 

Table  II  —  Persons  Serving  The  Patients  at 
the  Massachusetts  General  Hospital  (1919) 

Trustees 12 

Consultants 12 

Committee  Members 46 

Physicians  and  Surgeons      216 

Research  Physicians    9 

Nurses   455 

Orderlies  and  Maids    * TJ 

Technicians 8 

Social  Service :  Paid 24 

Volunteer 61 

Clinic  Secretaries  and  Laboratory  Volunteers 32 

Therapeutic  Assistants    5 

Library  Staff  and  0.  P.  D.  Records 15 

Household  Staff  v 112 

Engineers,  Carpenters,  Gardeners,  and 

Chauffeurs,  etc 17 

Clerical  Staff 20 

Total    1,121 

Table  III  —  Population  Served  by  the 
Massachusetts  General  Hospital  (1919)* 

Ward  Patients  (1917)    6699 

Out-Patients,  new  (1917)     31 104 

Out-Patient  visits  (1917)    203524 

Case  Record  Subscribers      1803 

Physicians  (2  weekly  public  exercises)  (about) 100 

Students:  Social  work  (a  week) 15 

Medical  Undergraduates  (yearly)    ....  270 

Medical  Postgraduates  (yearly)  (about)  300 

Nurses    (yearly) 224 

Total  (omitting  Out-Patient  visits)     40,515 

*Except  as  noted  in  first  three  items. 

12 


Concentration   of   Attention  and   Attack  Upon 
One  Disease  at  a  Time 

In  1905,  through  the  energy  and  ingenuity  of  Dr. 
J.  H.  Pratt  and  Dr.  John  B.  Hawes,  Jr.,  the  hospital 
assumed  a  new  attitude  towards  one  disease —  tubercu- 
losis, an  attitude  which,  I  think  may  be  characterized 
as  aggressive.  Instead  of  waiting  passively  for  disease 
to  present  itself  at  our  doors  in  the  persons  of  individual 
patients,  we  began  to  seek  it  out  in  its  own  lairs  with 
the  hope  of  crushing  it  altogether.  The  attack  upon 
tuberculosis  was  followed  not  long  after  by  the  attack 
upon  syphilis  as  a  separate  disease  and  by  the  organ- 
ization of  our  syphilis  clinic  under  Drs.  Abner  Post 
and  C.  Morton  Smith.  I  venture  to  believe  that  this 
clinic  has  no  equal  in  this  or  any  other  country,  and 
that  its  success  is  due  to  the  amount  of  attention  and 
interest  concentrated  upon  a  single  group  of  patients 
whose  problems  are  so  much  the  same  that  unusual 
skill  can  be  accumulated  in  dealing  with  them. 

Following  the  example  of  Dr.  Pratt's  tuberculosis 
class,  Dr.  F.  G.  Brigham  organized  five  years  ago  our 
first  class  for  diabetics,  which  has  since  been  a  very 
useful  and  instructive  feature  of  oui  work.  Since 
the  poliomyelitis  epidemic  (19 16)  this  disease  is  also 
treated  in  a  clinic  by  itself.  Hay  fever  and  asthma  are 
now  receiving  the  advantages  of  a  special  clinic  and 
staff,  the  advances  in  our  organization  corresponding 
with  the  advances  in  our  ability  to  treat  these 
diseases  successfully. 

The  clinic  for  industrial  diseases  established  by  Dr. 
Wade  Wright  just  before  the  war  emphasized  two  prin- 
ciples: first,  that  just  exemplified,  the  concentration  of 
attention  upon  one  group  of  diseases  in  isolation  from 
the  rest,  and  second  our  increased  awareness  of  the  in- 
dustrial world  and  the  mischief  wrought  by  it,  an 
awareness  shared  by  the  hospital  with  the  rest  of  society 
at  the  present  time. 

13 


Social  Service 

In  1905  came  the  organization  of  Social  Service  work, 
which  after  a  precarious  and  checkered  career  has  now 
become  an  established  part  not  only  of  this  but  of  all 
other  first-rate  hospitals  in  this  country,  and  has  re- 
cently taken  root,  through  the  efforts  of  your  foreign 
service  branch,  in  France. 

The  Circulation  of  Our  Case  Records 
In  This  And  Other  Countries 

Since  191 5  the  benefits  of  some  of  the  knowledge 
gained  in  our  hospital  have  been  spread  to  cities  and 
countries  very  far  from  our  gates.  It  has  always  been 
the  policy  of  this  hospital  to  serve  the  physicians  not 
connected  with  its  staff  so  far  as  this  service  was  con- 
sistent with  the  best  welfare  of  its  patients.  But  now 
by  means  of  published  records  of  our  work  sent  out 
each  week  throughout  this  and  other  countries,  we  are 
enabled  to  extend  our  service  very  much  further  than 
was  possible  before  191 5. 

The  standards  of  this  hospital,  its  standards  of 
record  systems,  of  physical  examination,  of  patholog- 
ical examination  after  death,  and  of  diagnostic  reason- 
ing are  thus  made  of  value  outside  our  walls. 

Table  IV  —  Subscribers  to  "Case  Records" 

United  States   1491 

(Massachusetts  96) 

Canada    65 

South  America   16 

West  Indies 1 1 

Canal  Zone   2 

Hawaii     4 

Philippines 6 

Europe 18 

Asia 11 

Africa 2 

Australia   101 


Clinic  Secretaries 

I  have  already  mentioned  the  advantages  in  the 
administration  and  organization  of  our  Out-Patient 
clinics  that  have  resulted  from  the  introduction  of 
clinic  secretaries.  This  was  primarily  the  work  of 
Mrs.  Roger  I.  Lee,  then  Miss  Ella  Lyman,  who  was  the 
first  to  demonstrate  to  the  hospital  authorities  that  a 
young,  well-bred  but  unskilled  girl  could  accomplish 
something  of  signal  usefulness  in  the  medical  routine 
of  the  institution.  There  is  nothing  like  this  so  far  as 
I  know  in  any  other  hospital,  but  doubtless  like  the 
other  inventions  of  this  institution  it  will  be  imitated 
elsewhere. 

Consultation  Clinic  For  Persons  Of 
Moderate  Means 

Just  before  the  war,  owing  to  the  progressive  attitude 
and  foresight  of  Dr.  F.  A.  Washburn,  the  hospital  took 
the  radical  step  of  establishing  in  the  Out-Patient 
Department  a  clinic  at  which  persons  on  the  payment 
of  $5.00  were  able  to  get  the  combined  services  of  the 
different  medical  specialties  now  necessary  for  a  thor- 
ough diagnosis  and  rational  treatment  of  disease.  It 
is  becoming  increasingly  obvious  that  no  single  phy- 
sician is  wise  enough  to  furnish  all  the  data  necessary 
for  a  modern  diagnosis.  The  co-operation  of  labora- 
tory experts,  X-Ray  experts,  specialists  in  the  different 
fields  of  medical  diagnosis,  is  often  necessary  if  a  com- 
mon disease  such  as  rheumatism  or  stomach  trouble 
is  to  be  traced  to  its  causes  and  properly  treated.  This 
clinic  for  persons  of  moderate  means,  unable  to  pay 
the  services  of  all  the  specialists  needed  for  the  proper 
study  of  their  cases,  was  an  innovation  in  medical 
service  and  pointed  the  way  to  another  of  the  most 
important  extensions  of  policy  ever  made  in  the  history 
of  this  hospital,  namely: 

15 


The  Rounding  Out  Of  Our  Hospital  Plan 
And  Policy  So  That  We  May  Serve  All 
Classes 

In  their  last  two  reports  the  Trustees  of  this  hospital 
have  taken  a  step  involving,  I  think,  signal  foresight 
and  courage.  They  have  resolved  to  put  this  hospital 
as  far  and  as  fast  as  they  can  at  the  service  not  merely  of 
the  poor,  as  it  was  before  the  erection  of  the  Phillips 
House,  or  of  the  poor  and  the  rich  as  it  now  is,  but  of 
all  classes  including  the  numerous  persons  of  moderate 
means  who  now  receive  a  most  unsatisfactory  type  of 
medical  service.  The  poor  and  the  rich  can  get-up-to- 
date  treatment;  the  great  body  of  those  financially 
intermediate  cannot. 

The  Organization  of  Research  Under  the 
Direction  of  Dr.  Edsall 

I  have  passed  over  without  mention  the  brilliant 
discoveries  of  Morton,  of  Henry  J.  Bigelow  and  R.  H. 
Fitz  which  brought  reputation  to  this  hospital  in  the 
earlier  years  of  its  existence.  It  is  not  likely  that  the 
quality  of  their  scientific  work  will  be  exceeded  in  the 
future.  But  it  may  be  pointed  out  that  the  work  of 
these  men  resembled  in  some  ways  the  gains  of  the 
earlier  Harvard  football  teams.  It  was  done  by  bold 
and  brilliant  individualists.  It  was  not  organized  or 
put  into  the  hands  of  those  whose  chief  purpose  centred 
here. 

The  beginning  of  this  new  organization  of  research 
work  is  due,  like  many  of  the  best  things  that  have 
happened  in  this  hospital  of  late,  to  the  advent  of  Dr. 
David  L.  Edsall.  Touching  the  high  points  in  the  hos- 
pital's history  we  might  say  that  the  tradition  of 
service  established  by  Jackson  and  Warren,  the  bril- 
liant discoveries  of  Morton,  Bigelow  and  Fitz,  and  the 
better  organization  introduced  by  Washburn  and 
Edsall  represent  the  peaks  of  our  achievement. 

16 


Prospects 
i.  closer  relations  of  trustees  and  staff 

What  now  of  the  future?  One  of  the  best  promises 
of  our  future  growth  is  contained  in  the  striking  in- 
crease in  activity  and  interest  manifested  by  the  Board 
of  Trustees  in  recent  years.  I  say  manifested,  for  what 
I  speak  of  is  wholly  what  the  staff  is  able  to  see.  The 
staff  has  always  known  that  the  trustees  were  at  the 
helm,  guiding  our  vessel  wisely.  But  until  within 
recent  years  we  have  seen  and  known  but  little  of  them 
and  their  activities.  Now  we  are  in  constant  touch 
with  them  and  we  know  that  they  are  carrying  out  the 
old  tradition  of  the  hospital  in  their  present  proposal 
to  appeal  for  new  hospital  funds. 

In  1816,  although  the  foundations  of  the  hospital 
had  not  then  been  laid,  the  Trustees  decided  to  make 
an  appeal  in  behalf  of  the  institution  over  which  they 
nominally  presided.  After  issuing  letters  and  circulars 
they  "divided  themselves  into  four  committees  and 
abandoning  their  private  affairs  for  a  season  they  went 
through  the  streets  day  after  day  soliciting  subscrip- 
tions from  all,"  and  in  this  way  raised  $846,000  within 
a  few  days.  Doubtless  we  shall  soon  see  committees 
of  our  trustees  taking  to  the  streets  on  a  similar  errand 
of  mercy. 

II.       BRING    THE   WORLD'S    BEST   HERE 

Judging  from  our  path  as  we  look  backwards  over  it, 
we  may  hope  to  continue  a  reform  begun  in  the  medical 
service  and  in  the  department  of  pathology,  namely, 
the  infusion  of  new  blood  into  the  hospital  by  bringing 
here  the  best  men  obtainable  from  outside  our  city. 
It  is  not  enough  for  the  hospital  to  do  its  ward  work 
conscientiously  and  to  organize  teaching  and  research 
within  its  walls;  it  must  also  extend  its  influence  and  its 
vision  extra-murally.  One  of  the  first  results  of  such  a 
vision  will  be  to  bring  us  new  blood.     Dr.  Edsall  ever 

17 


since  his  coming  has  personified  in  our  executive  com- 
mittee and  in  all  our  councils  a  wide  awareness  of  what 
is  going  on  in  other  medical  centres  of  this  country. 
He  has  never  let  us  fall  behind  or  get  left  out  of  any 
of  the  important  movements  towards  better  service 
occurring  elsewhere. 

May  we  not  hope  that  some  arrangement  may  be 
made  here  such  as  has  been  made  at  the  Mayo  Clinic, 
whereby  our  awareness  of  whatjs  going  on  in  the  med- 
ical centres  of  this  and  other  countries  may  not  be  left 
to  chance  or  to  the  transplantation  into  our  midst  of  a 
single  enlightening  personality  like  Dr.  Edsall?  As  we 
recently  sent  Mrs.  Myers,  the  head  of  our  medical 
library,  on  a  trip  to  familiarize  herself  with  the  other 
medical  libraries  and  record  rooms  of  the  country,  as 
we  recently  took  advantage  of  Dr.  Paul  D.  White's 
journey  to  England  to  have  him  bring  back  to  us  the 
best  of  knowledge  and  of  new  instruments  for  the  study 
of  the  heart,  so  we  ought  to  hope  that  in  some  way  the 
hospital  will  provide  for  a  constant  stream  of  new  in- 
formation from  outside  our  walls. 

III.       STUDY    OF    INTAKE 

We  have  begun  at  last  to  study  intake.  A  new  and 
enlightening  policy  of  the  trustees  now  focuses  our 
attention  upon  the  question: — "Are  we  now  taking 
into  the  hospital  such  persons  as  we  can  best  serve?" 
Hitherto  we  have  been  passive  in  this  matter.  We 
have  indeed  selected  among  those  who  came  to  us,  but 
we  have  never  reached  out  to  inquire  whether  there 
were  any  others  who  needed  us  as  much  as  those  whom 
we  are  now  serving,  or  perhaps  more,  but  who  are  not 
aware  of  our  existence  or  cannot  gain  admission  here. 
Perhaps  we  shall  soon  be  bold  enough  to  make  this 
hospital  really  known  as  it  should  be  known  to  those 
who  need  it.  The  word  "advertise"  is  not  in  line  with 
our  traditions,  but  we  must  accomplish  the  same  re- 
sults without  the  word. 


IV.      MEDICAL    ORGANIZATION    FOR   THE    PUBLIC    GOOD 

Our  recent  achievements  and  plans  make  it  possible 
to  hope  that  in  the  future  we  shall  organize  medical 
service  for  the  public's  good  without  any  fear  of  an 
indignant  medical  minority.  We  have  seen  so  much 
of  late  of  the  tyranny  of  minorities  in  other  fields  that 
I  think  we  are  awakened  as  never  before  to  their  dangers. 
If  we  serve  the  community  as  we  should,  we  shall  cer- 
tainly arouse  the  indignation  of  some  of  the  less  en- 
lightened of  our  professional  brethren.  We  have  done 
so  already  and  served  the  public  none  the  less.  We 
must  be  prepared  to  do  so  again. 

V.       EXCHANGE    OF    STAFF    MEMBERS    WITH    OTHER 
HOSPITALS 

This  year  for  the  first  time  so  far  as  I  know  in  our 
history  a  member  of  the  staff  of  this  hospital  has  been 
giving  medical  instruction  in  another  hospital,  the 
Peter  Bent  Brigham.  This  may  well  enough  become 
a  fruitful  precedent.  Why  should,  we  not  have  ex- 
change professors  and  exchange  hospital  services  along 
the  lines  already  laid  out  in  the  hospital  last  referred  to? 
Surely  such  an  exchange  would  increase  our  vision, 
extend  our  influence  outside  our  walls  and  bring  new 
life  within  them. 

VI.       EXTRA-MURAL    RESPONSIBILITIES 

It  seems  to  me  almost  inevitable  that  we  shall  take 
more  and  more  part  in  the  life  of  the  community  out- 
side our  walls.  The  patients  who  come  to  us  present 
a  sample  of  conditions  as  they  exist  in  the  community 
outside.  As  a  bucket  let  down  into  an  artesian  well 
or  into  the  ocean  brings  up  from  the  bottom  a  sample 
of  what  is  widely  distributed  there,  so  a  patient  with 
lead  poisoning,  with  tuberculosis,  with  a  court  record, 
with  a  truancy  record,  brings  us  into  touch  with  con- 
ditions which  we  should  not  ignore.     We  can  serve  the 

19 


community  by  assisting  the  schools,  the  courts,  the 
industrial  plants,  and  the  public  health  authorities  to 
quell  the  diseases  of  which  we  see  samples  in  our  Out- 
Patient  clinics  or  in  our  wards. 

VII.       END    RESULTS 

We  still  know  far  too  little  about  the  progress  of  our 
patients  after  they  leave  our  wards.  The  rebukes  and 
warnings  of  Dr.  E.  A.  Codman  in  relation  to  our  igno- 
rance of  our  end  results  are  for  the  most  part  deserved. 
From  the  point  of  view  of  science  as  well  as  of  humanity, 
in  order  that  we  may  improve  our  prognosis  and  our 
treatment,  we  ought  to  know  more  about  our  results. 
This  will  cost  money  and  time,  but  without  it  we  shall 
not  be  keeping  up  with  our  traditions. 

VIII.       THERAPEUTIC    RESEARCH 

I  cannot  but  hope  that  the  organization  of  research 
under  the  leadership  of  Dr.  Edsall  will  result  in  making 
the  general  plan  and  trend  of  American  medical  re- 
search less  one-sided.  We  have  had  a  tremendous 
amount  of  investigation  into  the  causes  and  nature  of 
disease.  We  needed  it  all  and  more.  But  surely  we 
should  balance  it  by  more  investigation  of  prognosis 
and  therapeutics.  Investigation  into  the  treatment 
of  disease  languishes  in  this  country.  Who  can 
undertake  it  better  than  the  research  group  now 
developed  at  this  hospital  under  the  leadership  of 
Dr.  Edsall? 

IX.       FURTHER    UNIVERSITY    CONNECTIONS 

Can  we  not  unite  ourselves  with  some  of  the  academic 
departments  of  Harvard  University,  both  for  their 
benefit  and  ours?  The  departments  of  sociology  and 
psychology,  of  physics  and  chemistry  surely  have  some- 
thing to  give  us  and  something  to  learn  from  us.  Are 
we  not  neglecting  some  of  the  opportunities  presented 
by  our  closeness  to  this  great  university? 

20 


X.       BETTER   CARE    OF    CONVALESCENTS 

The  Trustees'  plan  for  a  country  branch  and  the 
present  concentration  of  interest  in  convalescence  through 
(a)  occupational  therapy,  (b)  physical  therapeutics, 
and  (c)  the  special  interest  of  Dr.  John  Bryant,  leads 
me  to  hope  that  we  shall  take  the  lead  in  solving  the 
largely  neglected  problems  of  convalescence.  It  is 
unfortunately  true  that  in  our  ward  work  we  lose  some 
of  our  interest  in  the  patient  when  he  begins  to  con- 
valesce. This  means  a  loss  of  efficiency  in  the  institu- 
tion as  well  as  an  injustice  to  the  patient.  The  conva- 
lescence of  our  patients  might  be  shorter  as  well  as  more 
complete  if  we  put  more  energy  and  more  attention 
upon  it. 


I  have  passed  in  rapid  and  sketchy  review  what 
seems  to  me  most  important  in  the  standards,  achieve- 
ments and  prospects  of  this  hospital.  As  we  grow  in 
size  and  in  numbers  shall  we  be  able  to  keep  the  Jackson- 
Warren  spirit?  Or  as  we  develop  into  a  huge  and 
diversified  industry  shall  we  become  as  mechanical  and 
as  soulless  as  a  factory? 

We  shall  avoid  it,  I  think,  by  the  organization  of 
small,  relatively  independent  units  within  the  hospital. 
The  homelike  and  humane  spirit  of  a  small  institution 
such  as  this  hospital  was  in  the  first  half  century  of  its 
existence,  can  be  kept,  I  hope  and  believe,  if  we  can 
organize  the  different  parts  of  the  institution  into  rel- 
atively self-sufficient  units  in  each  of  which  the  ad- 
vantages of  smallness  and  intimacy  can  be  preserved. 

Shall  we  be  able  to  conserve  what  is  best  in  our  tra- 
ditions and  yet  to  grow  with  our  time?' 

I  believe  so,  because  we  shall  take  the  best  of  what 
is  new  from  outside  our  walls  and  domesticate  it  here, 
as  we  have  domesticated  Dr.  James  H.  Wright  and 
Dr.  Edsall,  always  aware  that  because  we  have  done 
good  work  in  the  past  we  all  the  more  need  reforming. 

21 


I  believe  we  have  never  done  work  as  good  as  we  are 
now  doing,  and  yet  I  trust  that  we  shall  never  in  future 
do  work  as  poor. 

Shall  we  be  able  to  keep  in  organic  unity  the  three 
proper  activities  of  a  hospital? 

I  believe  that  we  shall  not  lose  the  tradition  of  high 
standard  of  daily  work  because  we  shall  never  lose  our 
connection  with  humane  culture,  maintained  through 
the  interest  and  visits  of  our  trustees,  of  our  lady  vis- 
itors, and  of  our  volunteers.  I  believe  that  we  shall 
not  lose  the  spirit  of  scientific  research  because  we  shall 
realize  that  only  by  teaching  and  research,  only  by 
ever  closer  connection  with  academic  institutions  can 
we  free  ourselves  from  the  evils  of  routine  and  of  stag- 
nation. "I  read,"  said  Thomas  Arnold,  "enough  to 
keep  my  mind  in  the  state  of  a  running  stream;  for  it  is 
ill  drinking  out  of  a  pond  whose  stock  of  water  is  merely 
the  remains  of  the  long  past  rains  of  the  winter  and 
spring,  evaporating  and  diminishing  with  every  succes- 
sive day  of  drought." 

We  shall  keep  the  scientific  spirit,  the  spirit  of  the 
running  stream  because  it  is  necessary  to  avoid  stag- 
nation in  our  routine  ward  work. 

We  shall  keep  our  vision  and  our  influence  upon  the 
world  outside  our  walls  through  the  establishment  of 
exchange  services  and  exchange  professorships,  through 
the  initiative  of  our  social  service  department  and 
through  the  cosmopolitanism  of  the  best  members  of 
our  staff. 


22 


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The  achievements .  standards_and 


prospects  of  the  Massachusetts 


A. 


